Provider Demographics
NPI:1447893797
Name:KIPTUM, AGNES MAURYN JEPKOGEI (FNP-BC)
Entity type:Individual
Prefix:
First Name:AGNES
Middle Name:MAURYN JEPKOGEI
Last Name:KIPTUM
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7801 SANDSMERE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80908-5027
Mailing Address - Country:US
Mailing Address - Phone:719-229-8932
Mailing Address - Fax:
Practice Address - Street 1:6908 MESA RIDGE PKWY
Practice Address - Street 2:
Practice Address - City:FOUNTAIN
Practice Address - State:CO
Practice Address - Zip Code:80817-1533
Practice Address - Country:US
Practice Address - Phone:719-471-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-18
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0995142-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily